HCLF: Halamka discusses standards to come

CHICAGO—As a Pioneer Accountable Care Organization (ACO), Beth Israel Deaconess Medical Center in Boston created registries and repositories to help with its quality measurements, said John D. Halamka, MD, CIO, speaking during the Healthcare Leadership Forum on Nov. 15.

Beth Israel’s EHR system is home built, web-centric and mobile friendly, Halamka said. A system of alerts and reminders helps clinicians meet quality metrics and fulfill the goals of Meaningful Use (MU). “I’m not sure I’d call it a clinical decision support system or evidence-based medicine but it sure is helpful. It’s big data.”

Beth Israel lets the data sit in the data centers where they are generated and users use a tool to send questions to the data rather than the data to the repository, he explained.

The organization’s 3,000 doctors use a range of tools, some self-built and others from a variety of different vendors. They use MU standards to ship 5,000 summary records a day to a common repository where a third party normalizes the data. “We can then take the dataset and provide provider scorecards and feedback so they can understand how their practices are varying. We built a management structure that ensures they get this feedback because standardized work will increase quality and outcomes and lower costs.”

As co-chair of the national HIT standards committee, Halamka has been working to improve EHRs and the standards used. “If we don’t resolve the tension, doctors are going to go nuts with popups and things that will cause such fatigue and offer no help.”

Fifteen percent of all radiography tests are redundant and wasteful, he said. To help address that issue, he said next month the standards committee will lay out a set of guidelines that will “go beyond DICOM today to more interesting architectural approaches for image sharing. That will give us some data that maybe are not computable but helpful for care coordination.”

The clinical quality measures for MU Stages 1 and 2 are “extremely painful to collect and report,” he said. The U.S. doesn’t have a national healthcare identifier and “it’s highly unlikely that we will,” which is a big challenge, he said. "We actually don’t even have uniform standards for ordering labs yet."

“We depend on vendors for cool new functionality but the companies’ agendas are so full. It’s highly unlikely there will be rapid, groundbreaking innovation.”

Halamka said he imagines potential standards for clinical decision support. “Knowledge representation in a standard is good but it’s really hard. A lot of CDS systems are much more complex than a simple query-response approach.” He said he thinks systems will have the ability to ask questions and interact with a system but knowledge representation could take a long time.

He also said some patient-generated data are going to be very helpful in determining medication regimens. “There are things a patient knows far better than us,” and new iterations of EHRs will “enable all of us to generate questions and answers and incorporating them into the EHR so we can use them for decision support.”

As he moves forward with his ACO, Halamka said he is “having to build a novel CDS evidence-based medicine system for cohorts of patients in global, capitated risk contracts to keep them continuously well as opposed to treating them for episodic illness.”

The Healthcare Leadership Forum was sponsored by Clinical Key and presented by Clinical Innovation + Technology .